Let Food Be Thy Medicine:What we eat matters for patients, ourselves and our environment

Sonya Pflanzer, MPAS, RD, CCMS, PA-CSurvivorship ClinicMoffitt Cancer Center

Objectives

Identify the importance of engaging our patients in nutrition-related guidance during oncology-based clinical practice

Review current nutrition guidelines for cancer and chronic disease prevention; how to incorporate them into clinical practice and personal space

Discuss the impact of healthy diet on environmental sustainability

Rate of Obesity is 37.7%

Obesity rates survivors referred to Survivorship Clinic

Body Mass Index (BMI)

N=657 % in Survivors

< 25 229 34.9

25-29 219 33.3

Class I 30-34 122 18.6

Class II 35-39 59 9.0

Class III >40 28 4.3

65% are BMI>25

32% BMI>30

Advise patients on current weight status and whether there is need to lose weight or prevent weight gain based on BMI category and considerations regarding disease state and treatment; encourage regular exercise and healthy eating at all points from diagnosis to long term follow up in all patients, regardless of weight status; highlight positive impact that improved diet and increased physical activity can have, including better quality of life, less fatigue, better body image and lower incidence of comorbidity

Refer patients to appropriate services, such as oncology nutrition, rehab medicine, and exercise physiology

8

9

Transition to the New American PlateAICR.org

Stage 1: The Old American Plate Stage 2:The Transitional Plate Stage 3:The New American Plate

Image: American Heart Assoc

Whole Grains: Going Against the (Refined) Grain

Dietary Fiber: Fiber Is Your Friend.

Fruits and Vegetables: More Is More

Protein: Animal vs. Plant Power

Fats: The Good, the Bad and the Ugly

Sugar: Less Is More.

Going against the (refined) grain

Examples: Quinoa, whole wheat, farro, barley, whole oats

Meal planning tip: Make a pot of a “grain of the week” weekly and multi-task it for breakfasts, lunch bowls and dinner sides.

Whole grains

image: flour.com

Dietary Fiber: Fiber is your friend.

Dietary Fiber25-35g/day

Soluble Fiber:Dissolvable in water,

lowers LDL.

Insoluble Fiber:Aids in digestion and increases stool bulk

oats, peas, beans, apples, citrus, carrots, barley

whole wheat flour, wheat bran,

nuts, beans, cauliflower, green beans, potatoes.

Meal Planning Tips:Add cooked whole grains like quinoa and farro as well as nuts and fruits to salads

Add whole uncooked oats and seeds (chia, flax) to smoothies

Lightly toast sprouted grain or whole grain bread for enhanced flavor and texture, top with ricotta cheese or avocado.

Try hummus and bean dips as a sandwich spread for added fiber and protein.

Fill ½ of your plate with fruits and vegetables.

S.A.D. standard american

diet 12-15g/per day

fiber

Image:aicr.org

Fruits and Vegetables: More is More.

Images: AICR.org

Source: USDA

Meal Prep Tips:-Try roasting and air-frying vegetables for use on sandwiches, salads, as sides or in omelets

-Frozen fruits and vegetables are economical and frozen at peak of freshness

-Dried, unsulfured fruits make great snacks paired with nuts, top hot cereals and salads

-Invite kids to select fruits and vegetables when shopping for more buy-in

-Substitute spiralized vegetables or spaghetti squash for pasta. Check out the ready-spiralized veggies in the produce department.

Protein: Animal vs. Plant Power Over-served?

What we need: 46-56g protein/ day**possibly higher based on activity and stress levels

What we consume: 100g protein/ day

Complete Proteins:Animal sources: eggs, fish, chicken, etc.

Plant Sources:Quinoa, Amaranth,Soy

Complementary Proteins:Beans + RiceHummus + PitaPeanut butter sandwich

Image: Nutrition.org

Meal Planning Tip: The Protein Flip

Classic Chicken Marsala Mushroom and Chicken Marsala BowlRecipe and Images: Cooking Light

18

Fat: The Good, the Bad and the Ugly

Image: Harvard TH Chan School of Public Health

Sugar: Less is more. 20

-Cut the sugar from morning coffee/ tea--Try not to “drink” your calories, hydrate with unsweetened beverages-Read labels- Look at added sugar amount-Ingredients are listed by weight, try to keep sugar out of the first 3-Enjoy dark chocolate, fruit, or bake your own treats with less added sugar

3500 calories= 1 pound of weight

Sugar1 tsp = 4g

Women 24g/day, 6 tspMen 36g/ day, 9tsp

Image:health.Harvard.eduImage:americanobesityassoc.

22

23

-Summary Report from EAT- Lancet Commission

24

eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/

Eat food.Not too much.Mostly plants.

-Michael PollanIn Defense of Food

26

References-AICR.org-Myplate.gov-ACS.org-Healthmeetsfood.com- CCMS courseware-USDA.gov-Heart.org-eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/-Wri.org/shiftingdiets-ciaprochef.com/MOC/PFbytheNumbers-Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. J Am Coll Nutr. 2008;27(2):287-298. doi:10.1080/07315724.2008.10719702-Kreuter MW, Chedda SG, Bull FC. How does physician advice influence patient behavior? Evidence for a priming effect. Archives of Family Medicine. 2000;9(5):426-433. doi:10.1001/archfami.9.5.426.-Jennifer A. Ligibel, Catherine M. Alfano, Kerry S. Courneya, Wendy Demark-Wahnefried, Robert A. Burger, Rowan T. Chlebowski, Carol J. Fabian, Ayca Gucalp, Dawn L. Hershman, Melissa M. Hudson, Lee W. Jones, Madhuri Kakarala, Kirsten K. Ness, Janette K. Merrill, Dana S. Wollins, and Clifford A. HudisAmerican Society of Clinical Oncology Position Statement on Obesity and CancerJournal of Clinical Oncology 2014 32:31, 3568-3574-Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003 Jun 26;348(26):2599-608. doi: 10.1056/NEJMoa025039. PMID: 12826634.

27

References cont.-de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85. doi: 10.1161/01.cir.99.6.779. PMID: 9989963.-Buckland G, Travier N, Cottet V, González CA, Luján-Barroso L, Agudo A, Trichopoulou A, Lagiou P, Trichopoulos D, Peeters PH, May A, Bueno-de-Mesquita HB, Bvan Duijnhoven FJ, Key TJ, Allen N, Khaw KT, Wareham N, Romieu I, McCormack V, Boutron-Ruault M, Clavel-Chapelon F, Panico S, Agnoli C, Palli D, Tumino R, Vineis P, Amiano P, Barricarte A, Rodríguez L, Sanchez MJ, Chirlaque MD, Kaaks R, Teucher B, Boeing H, Bergmann MM, Overvad K, Dahm CC, Tjønneland A, Olsen A, Manjer J, Wirfält E, Hallmans G, Johansson I, Lund E, Hjartåker A, Skeie G, Vergnaud AC, Norat T, Romaguera D, Riboli E. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer. 2013 Jun 15;132(12):2918-27. doi: 10.1002/ijc.27958. Epub 2012 Dec 19. PMID: 23180513.